Clinical analysis of pacing therapy and treatment of complications during follow-up in children

Abstract

Objective: To analyze characteristics of permanent pacemaker implantation in children as well as treatment and prognosis of complications. Method: Clinical data of children who underwent endocardial or epicardial permanent pacemaker implantation between April 2000 and June 2016 in Shanghai Xinhua Hospital and Shanghai Children's Medical Center were analyzed retrospectively. These patients were discharged 5 days after implantation. Electrocardiogram, chest X ray, echocardiography and pacemaker programming were performed during follow-up. Treatment regimes, complication management and prognosis were analyzed retrospectively. Result: Data of a total of 193 cases were collected. One hundred and six patients were male and 87 patients were female.The average age was (5.09±4.05) years(0.4-16 years)and the average weight was (20.47±11.62) kg.133(68.9%); patients were implanted with endocardial pacemakers and 60(31.1%)patients were implanted with epicardial pacemakers; 135(69.9%)patients were single-chamber paced with 87 from RVA and 48 from RVOT. fifty-eight(30.1%)patients were dual chamber paced. These included 122(63.2%)postoperative third degree AV block(Ⅲ-AVB), 38 (19.7%)congenital complete AV block (CCAVB), 3(1.6%)post ventricular septal defect (VSD) interventional therapy AV block, 23 (11.9%)sick sinus syndrome (SSS) and 7(3.6%)Ⅲ-AVB after fulminant myocarditis. One hundred and thirty-seven(71%)patients were followed up for an average duration of 5.32 years(0.3-10 years). Pacemaker exchange were performed in 46 patients due to battery exhaustion.The average life of battery was 5.4 years (1-9 years). Sixteen patients underwent lead exchange due to dislocation or separation.One patient underwent lead extraction due to recovery of AV conduction 21 days after surgery for complete transposition of great arteries (D-TGA/VSD). Skin abrasion, infection or dehiscence occured in 6 patients. Heart failure occurred in 2 patients at 6 and 8 years after implantation whose heart functions improved after switching from VVI to DDD or adding ACEI . One patient died suddenly due to ineffective pacing caused by lead fracture. Another patient under DDD pacing was found to have atrial myocardial perforation with normal sensing and pacing so that no intervention was performed. Conclusion: The pacing mode and path through which leads are implanted for permanent pacemaker implantation in children have their peculiar characteristics.Some complications might occur during follow-up with good prognosis if appropriately treated.